PROJECT SUMMARY Although the recent literature has indicated that children receiving cochlear implants (CIs) often have dramatically improved speech and language ability relative to previous generations of children with hearing loss, many pediatric CI recipients display persistent speech and language disorders despite early implantation and associated speech/language intervention. There is a striking paucity and ongoing need for studies that systematically examine the relationship between intracochlear electrode location, audiological profile, and subsequent phonological awareness, speech, language, and literacy in pediatric CI recipients. This project provides a unique opportunity to examine whether individualized, image-guided CI programming (IGCIP) significantly improves outcomes in pediatric CI patients. The proposed research activities will examine the impact of personalized IGCIP in pediatric CI recipients on measures of basic auditory function (spectral, temporal, and spectrotemporal resolution), word and non-word recognition, speech production, language, phonological awareness, and reading comprehension using a double blind, waitlist control randomized clinical trial (RCT) design. A total sample of 72 children with CIs aged six to twelve years old will be enrolled in the project: half (n = 36) will be randomized to an immediate IGCIP condition and half to a waitlist control condition. The waitlisted participants (n = 36) will undergo IGCIP after 12 months of monitoring and then followed for an additional 12 months after intervention (total time in the study for both groups: 24 months). Those immediately provided with IGCIP will also be followed for a total of 24 months. All participants will undergo extensive audiological assessment as well as tests of phonological awareness, speech, language, and literacy at baseline as well as at regular intervals: 2, 6, 12, 14, 18, and 24 months. We will use predictor analyses to determine the impact of immediate and deferred IGCIP on subsequent auditory, speech, language, and literacy outcomes.